Obstetrician-Gynecologist, Permanente Medical Group, San Leandro, CA.
Senior Research Scientist, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta.
Perspect Sex Reprod Health. 2018 Jun;50(2):67-73. doi: 10.1363/psrh.12056. Epub 2018 Mar 30.
Women who are living with HIV use IUDs at a lower rate than the general population, and it is unclear whether health care providers' misconceptions about IUD safety contribute to this disparity.
A 2013-2014 nationwide survey of 1,998 U.S. family planning providers assessed perceptions of IUD safety for women with HIV or other medical conditions. Multivariable logistic regression was used to examine associations between provider characteristics and whether individuals believed IUDs were safe for HIV-positive women. Data from public-sector providers and office-based physicians were analyzed separately.
Seven in 10 providers considered IUDs safe for women with HIV, and there were no differences by provider type. Among public-sector providers, some of the characteristics associated with believing that IUDs were unsafe for seropositive women were working at a clinic without Title X funding (odds ratio, 1.5), not being trained in IUD insertion (2.1) and not using the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) for clinical guidance (1.8). Office-based physicians who did not use the guidelines also had an increased likelihood of believing that IUDs were unsafe for women with HIV (2.9), and physicians who had completed training 25 or more years ago were more likely than those who had done so less than five years ago to consider IUDs unsafe (3.3).
Greater use of evidence-based contraceptive guidance such as the U.S. MEC may help inform provider perceptions of IUD safety and hence contribute to increased contraceptive choice for women with HIV.
与一般人群相比，HIV 感染者使用宫内节育器（IUD）的比例较低，目前尚不清楚医疗保健提供者对 IUD 安全性的误解是否导致了这种差异。
2013-2014 年对 1998 名美国计划生育服务提供者进行了一项全国性调查，评估了他们对 HIV 或其他医学状况女性使用 IUD 的安全性的看法。多变量逻辑回归用于检查提供者特征与个人是否认为 IUD 对 HIV 阳性女性安全之间的关联。对公共部门提供者和以诊所为基础的医生的数据分别进行了分析。
十分之七的提供者认为 IUD 对 HIV 感染者是安全的，且提供者类型之间没有差异。在公共部门的提供者中，一些与认为 IUD 对血清阳性妇女不安全相关的特征包括在没有 Title X 资助的诊所工作（比值比，1.5）、没有接受 IUD 插入培训（2.1）和没有使用美国避孕方法医学标准（U.S. MEC）作为临床指导（1.8）。不使用指南的以诊所为基础的医生也更有可能认为 IUD 对 HIV 感染者不安全（2.9），并且完成培训 25 年或更长时间的医生比在不到五年前完成培训的医生更有可能认为 IUD 不安全（3.3）。
更多地使用基于证据的避孕指导，如美国 MEC，可能有助于告知提供者对 IUD 安全性的看法，从而增加 HIV 感染者的避孕选择。
